A Quixotic note regarding Noakes

That title, because I do think it an implausible and potentially unreachable goal to convey (relatively) subtle points about epistemology when the points in question relate to an emotive topic, namely our health and diet.

According to a few folk on Twitter, my blog posts on the topic have amounted to “rabid attacks”, which I find distinctly odd, seeing as the only ad hominem – and emotionally animated rather than merely critical – engagements I’ve seen have been directed at those of us who dare to challenge anything related to the LCHF diet and its proponents.

So, in bulleted points to try to minimise confusion, here are my concerns and positions. These are the same concerns and positions I’ve expressed from the start, contrary to what some “rabid” comments have claimed in response to my posts and columns on the topic.

  • Regardless of the efficacy of the LCHF diet in treating various conditions, and regardless of the truth or falsity of hypotheses assumed by the LCHF diet, we should all have a concern for good scientific thinking, and clear reasoning in expressing the conclusions we’d like to see adopted. Science does not work in absolute truths – it’s an inductive process, whereby we chisel away at falsehoods to arrive at a clearer understanding of what’s most likely to be true.
  • That project of triangulating on the truth is harmed by expressing scientific claims in absolutist language, and by creating movements akin to cults, where people are more likely to forget that anecdotes aren’t data, that being wrong in the past doesn’t guarantee you’re right now, that emotional commitment leads to confirmation bias, and so forth.
  • My criticisms of Noakes have mostly been that – whether or not he’s right – he doesn’t present his case in a way which demonstrates sound scientific reasoning. We reveal ourselves when we “show our working”, and it’s not reassuring to see anti-vaccine quacks and evolution-deniers quoted approvingly when arguing for LCHF. It demonstrates a desperation to make a case, and a lack of sound judgement.

Likewise, not focusing on the details, or the evidence, is a bad sign. Take this tweet as example:

  • It references the UCT Health Sciences Centenary Debate between Dr. Jacques Rossouw (my father) and Noakes. But notice how it references it – by dismissing me as a latecomer who somehow rushes in to defend my father’s cause. However, the evidence shows that I was writing about this 9 months before that debate, and that Rossouw père hasn’t been engaged with Noakes at all for around 20 years, and only got involved in this debate on an invitation from the Medical School when an ex-colleague had learnt that he was coming here on holiday. It misrepresents (a truly rabid critic might even say “lies”) to further a particular narrative.
  • Likewise, it’s misrepresentation to tweet (as Prof. Noakes regularly does) links to Noakes’ SAMJ article criticising the WHI study that Rossouw directed without acknowledging that there were at least two responses to the Noakes article, arguing that his criticisms are misguided.
  • A summary of the problem might be this: Noakes’ audience is primed to believe, and primed to think that critics are deluded, because of the narrative they’ve been told, and because their anecdotal experience (in the short-term, at least) confirms that narrative. And then, the way in which Noakes responds to critics (e.g. “I ignore what I consider not to be evidence“) seems to do little to help them think critically about science, because criticism starts – and sadly, also ends – with the charge that traditional views of diet are deluded.
  • It’s entirely possible that the long-term harms of high meat or fat consumption are overstated, and therefore that Noakes is right. But I can’t imagine him saying that it’s entirely possible that we don’t yet know if there are long-term harms from following his advice, or that it’s entirely possible that a moderate diet, involving a focus shift away from any single or particular macronutrients, might be best for most people. Nothing seems possible, except that he’s right.
  • Then, the LCHF crowd get relationships and potential taint utterly wrong in any case – just because someone works for “Big Food”, the FDA, the South African Heart Foundation or whatever – or is someone’s father/son – doesn’t absolve you of the need to make and respond to arguments. Sure, the connections can lead to the increased probability of some sort of bias, but you still need to show the bias, and not simply evade challenges by asserting it.

I’ve written at length about logic, epistemology, scientific reasoning, anecdotes and their irrelevance, and other issues to do with Noakes’ warrant for presenting his case with the degree of certainty that he does. I’ve said very little about the diet itself, because that is not my focus – and it doesn’t need to be my focus.

The retort that there is “bad science” on the other side is not compelling, in that it’s a) bad science (if it is) mostly because the LCHF people think it reaches entirely the wrong conclusions; and/or b) because it uses poor data. My accusations of “bad science” are premised on the selective quotations, dubious authorities cited and so forth as demonstrated in social media, rather than being about “bad science” in the sense described in (a) and (b) above.

To capture the essence of the only things I have ever said about diet specifically

  • I’m concerned about the affordability of the LCHF diet for poorer populations.
  • I can see how people might be concerned about animal welfare and an increase in the farming and killing of animals. I eat meat, but think it’s a moral failing that I do – and furthermore, I think that the immorality of meat-eating will be the subject of a moral consensus in my lifetime.
  • Independent groups like the Harvard School of Public Health continue to caution against excessive consumption of saturated fat.
  • I’m not at all persuaded by what LCHF folks assert as evidence of the failure of the so-called “prudent diet” – first, because it’s not at all clear that people have ever been eating that way (in general); and second because it caricatures dieticians as having recommended a diet that they claim they aren’t recommending at all. A series of blog posts at Nutritional Solutions are worth reading in this regard.
  • In short, the increase in obesity and the like still seems mostly explicable by the advent of television, increased access to motorised transport, desk-bound lifestyles, and excess consumption of food.
  • Yes, it certainly seems true that fats (in general) have been demonised far more than they should have, and that some of us might have started eating too much of other things (including carbohydrates, especially in the form of sugars) to compensate for a flavour-deficit after shunning fat.

This doesn’t, however, automatically lead to the conclusion that carbohydrates are in general bad, nor to the conclusion that we need no longer be at all concerned about the long-term effects of a diet with significant levels of saturated fat. “Real food” is good, sure – and refined carbs are “bad”. And what that means is, when you carry on eating your modest portions of a balanced diet (which is surely what you eat, right?), you should continue to be wary of including too many processed and refined foods.

That’s what I’ve always been told. What’s “new” is that fats aren’t as bad as we thought, and I (along with many of you, no doubt) were misinformed when we were told that they were rather evil. The truth is probably in the middle somewhere – and why replace one exaggerated position (“fats will stop your heart!”) with another (“carbs will give you diabetes!”).

As Oscar Wilde had it, “the truth is rarely pure and never simple”.


Also published on Medium.

  • albie_cilliers

    A very sensible post that unfortunately will mean nothing to the senseless, gullible masses to which Prof Tim Noakes preach and market his advice and books.

    • Adolfo Neto (UTFPR)

      Senseless and gullible. You are quite wrong.

    • Andre Kruger

      The posts from Jacques Rousseau does not comment on the advice given by Prof Tim Noakes but rather wants to promote good science and reasoning. On which science do you base your conclusion that the advice given to “senseless, gullible masses” are incorrect?

      • albie_cilliers

        There are many scientific sources out there which I have spent most of the last 2 years of my life researching since my son’s diagnosis of T1 diabetic. I have done nothing in my life that comes close as to the time and effort I have put in researching these things, and this includes 9 months of a ketogenic diet for myself and children. Blindly following the “advice” of Prof Tim Noakes destroyed the health of one of my other sons, an active sports person. Luckily I found the truth after 3 months of running between specialists and doctors, and spending thousands of rands on all kind of tests and scans to no avail. Simple sugar and carbs in his diet “cured” him again!. It is exactly this reason why I criticise the reasoning of Prof Tim Noakes and the sources of science he quotes to try and rationalise his view. He completely disregard science that is counter to his arguments. It unfortunately takes a LOT of time to read these things yourself and most people are way to lazy, just dont care, or are unable to do their own research and would prefer to just believe a “guru” like Tim Noakes. A good scientist looks especially hard at the counter evidence of his hypothesis. Tim Noakes would rather just ignore those and pretend they don’t exist or argue that they are not good research. To a man with a hammer, everything looks like a nail. In Tim Noaks’ view all ill’s in this world are the cause of carbs.

        • Andre Kruger

          There are lots of people who was positively influenced by Prof Tim Noakes “advice”, but this is anecdotal, just as your son being “cured” by simple sugar and carbs. He is very clear that the diet might not be for everyone.

          The fact is that a low fat diet is not working for everyone. It is important that people be informed about alternatives and be able to try it for themselves. There are a lot of science out there in support of LCHF. Just because it is not mainstream does not mean it is bad advice.

          Maybe the science can go either way, but LCHF is a viable option for a lot of people and should be considered.

          There is no science that rules out LCHF as an option for some people.

          • “Banting is not just for overweight people and diabetics – it is a good plan for everyone, for life.” Real Meal Revolution, page 28. Very clear.

            • Sam

              But in RMR noakes clearly states that for athletes who can handle carbohydrates, they do not have to limit their CHO intake. Don’t be a selective quoter

            • And, don’t be wilfully obtuse. I was responding to “he is very clear that the diet might not be for everyone”. That’s a different claim to the one you’re referring to, which is that the diet shouldn’t be considered the *only* option for everyone. Words are expressed in a context.

            • Sam

              With reference to Albie’s comments on his son who suffered as an athlete… Simply reading the whole book could’ve found him a solution. Selective reading … Selective quoting.

            • Then, you should have responded to Albie, not me. Did you make a mistake, or are you lying?

  • gail

    I think this was a measured and calculated post. With good points. I cannot say I have always experienced your views as this measured though.

    • Then perhaps you could have pointed out the failures in being measured – simply asserting that I wasn’t doesn’t inform me (and is also contradicted by the evidence, in my view).

      • Simon Williamson

        For one, I think Jacques is absurdly measured. Sometimes I wish he’d hand out a big sack of fuck off when people bring really dumb shit to him on Twitter.

  • Lorne Morrow

    Maybe part of the problem is how various academics and non-academics use Twitter. I would suggest that a better protocol might be for academics like you & Noakes, to use Twitter only as a means to link to blog posts or publications wherein writing is potentially more thoughtful and lucid. The 140 character repartee is too immediate (therefore, likely to be more emotionally charged) and highly restrictive – leading to inappropriate shortcuts in language use. Then non-academics might have to patiently wade through something of more depth before jumping on or off a bandwagon. Respected and respectful professionals such as you & Noakes will be less likely to take offence as your exchanges will be less off-the-cuff. I am just a personal trainer in a remote town in Canada and I use Twitter to chase down academic threads on many topics. But when I started, I made many poor judgements based on a limited number of tweets or parries between parties. Now that I act more thoughtfully, I get more measured perspectives. Good for you for writing this post. However, being the more-expert in the field of critical thinking, bad for you for taking so long to do so. But please understand the goodness of this post far, far, outweighs the negative aspect of your delay in writing it. Thank you for writing this post.

    • I do appreciate the tone of your comment. But saying it took me so long to write it implies that my previous posts have been intemperate – if you read them neutrally, I’m not sure that’s a sustainable position. What I’ve done here is to repeat and consolidate points – I’ve said nothing contrary to previous posts.

      • Lorne Morrow

        Sorry. No. I worded it poorly. I meant that I thought you would have picked up on the need to write this post based on the rabid comments from so many of the so-called believers.

  • Andri Hanekom

    What about the study done by Cambridge University, that was published in the latest issue of Annals of Internal Medicine? A review of 72 studies, and shows no correlation of saturated fats with heart disease. http://annals.org/article.aspx?articleid=1846638

    • What about it, indeed? It has zero relevance to the over-arching theme of this post. Also, nothing is settled by that study – it adds valuable data points, sure, but still leaves many questions unanswered. See this response as an example http://linkedin.com/today/post/article/20140318132400-23027997-the-new-dietary-fat-study-what-you-ll-hear-and-what-it-really-means

      • Adolfo Neto (UTFPR)

        Have you read Nassim Taleb’s latest book, Antifragile.
        Read it.
        It seems you are placing the burden of evidence on the wrong side.

        • Yes, I have. But introducing the burden of proof merely indicates that you’ve completely missed the point of this post. It’s not about who is right.

          • Adolfo Neto (UTFPR)

            Well, you wrote:
            “My criticisms of Noakes have mostly been that – whether or not he’s
            right – he doesn’t present his case in a way which demonstrates sound
            scientific reasoning.”
            >> According to Taleb (and I agree with him), sound scientific reasoning should not be necessary for most of the things that prof. Nokes says.
            But I agree with your main points. He sometimes writes as if Science had proved that LCHF is the best thing.

        • Adolfo Neto (UTFPR)

          Not that I don’t have my concerns with Prof. Tim Noakes excess of enthusiasm 🙂

  • greg

    What is sad to me is that since he has revealed himself to be a sloppy scientific thinker, that all his research must be called into question.

    • albie_cilliers

      This is the real danger, and very sad indeed. I think Jacques mentioned the word “desperate” somewhere and I think it is very applicable here too, since this is my takeaway from many of his (Noakes’) comments. You can only imagine if he were to proven wrong, again, on many of his current outrageous claims.

  • Hugh Wallace

    Jacques,

    Just read through the entire string of posts related to Tim Noakes and wanted to say that while I am, in general, a fan of LCHF ideas I am also an even bigger fan of informed debate, evidence and the like so thank you for expressing your thoughts and criticisms the way you have done. I suspect (want?) to think that that Noakes et al are correct in their assertions but a little bit less rhetoric, a little less certainty and a little bit more willingness to embrace complexity is always a good thing.

    That said, there is room in the debate for evidence that isn’t of the gold-standard double-blind variety, and it should be acknowledged that advice has to be aimed at the majority of the population while being flexible enough to be tailored for the individual. But I doubt you disagree with that basic idea.

    One entirely inconsequential side-note regarding a comment you made at least twice about being ethically concerned about the number of animals that would be raised and killed if Noakes’ ideas become the mainstream; while I can appreciate your ethical concern and that should be a factor in the policy decisions taken at a society level it should not be a factor in determining if it the healthiest diet for the human animal. Nor should whether the poor can afford the ideal diet or not be a factor in determining what that diet is. To consider either would be getting in the way of the science but both should definitely play a part in how the science informs policy further down the track.

    I enjoyed your writing so thank you again.

    Hugh

    • Thanks Hugh, and agreed – we potentially face difficult trade-offs between ethical considerations of one sort (non-human animals and economic viability) and others (human welfare). That’s just one reason why there always needs to be room for nuance in these debates.

  • Amphibian King West

    Hi Jacques, reading your posts with great interest. As someone who likes the basis of the LCHF diet as a concept for my own dietary changes, my question is not about the diet itself (I think any dietary changes should be explored by each individual and put to self-experimentation for results).

    Instead I wonder is it simply a questioning of the methodology and alledged science behind the claims that you have issue with? Do you think there is any likelihood that Prof Noakes is correct in his assumptions but is proving it the wrong way?

    Forgive me if you have addressed this, I’m still working through the series and all the links too.

    In any event, thank you for provoking thought.

    • There’s certainly a possibility that he and others are right. As I’ve tried to emphasise, it’s the tone and content of the argument for the conclusion – not the conclusion itself – that I’m addressing.

      • Amphibian King West

        Thanks Jacques and I see you spelled that out clearly in Post 3. Apologies.

  • Ikes

    I’ve been following your criticism of Tim Noakes and his diet with much interest. Even though I think the diet and its theories has some merit, I have been disappointed how Prof Noakes has conducted himself on social media esp Twitter. Countless anecdotes and random links to articles with anything remotely associated with LCHF and it’s benefits are retweeted. Particularly annoying are tweets from people talking of cures of medical conditions ranging from fibromyalgia and epilepsy. By retweeting such claims he suggests he agrees with them. That’s not science. It’s wild conjecture and confirmation bias at its best. There’s no critical scrutiny or cautious view. Basically he doesn’t come across at all like a scientist which is a pity. I think you are doing a very good job of pointing this out. Thank you.

    • albie_cilliers

      Well said. I couldn’t agree more.

  • Andre Kruger

    If you want to approach this debate from a purely scientific perspective. From your article: “In short, the increase in obesity and the like still seems mostly explicable by the advent of television, increased access to motorised
    transport, desk-bound lifestyles, and excess consumption of food.” Various studies have shown that exercise does not contribute to weight loss. Those studies are referenced in “Good Calories, Bad Calories”.

    If you are a defender of good science, why not also point at the “bad science” that went into the saturated fat is bad for you hypothesis.

    As somebody close to 40 I cannot afford to wait for for the holy grail of RCT’s to prove something. It will probably never come. What has it done for us thus far? I’ll rather do an experiment on myself (N=1) to see what works for me. I have already done the low fat more exercise study numerous times before. It didn’t work. LCHF worked for me. People are sick out there. It is important to get the message out that there is another option and it might just work for them.

    Fact: Blood glucose control is very important for diabetes. No diet offers better blood glucose control than LCHF.

    The conventional wisdom is saturated fat raises your cholesterol which “clogs” your arteries. That is all I knew. With Tim Noakes championing LCHF I actually know that saturated fat might raise your LDL but it will be consist of a larger percentage large particles. But it also drops your triglycerides and raises your HDL. If it is combined with a lower carbohydrate consumption it leads to lower blood sugars. I have a much more specific knowledge of what the effect of certain foods is on my body than ever before.

    So how about it? Why don’t you also point at the “science” that went into avoid saturated fats because it “clogs” your arteries.

    • I explain why I decline your ‘how about it’ in the post. But you’re clearly not reading it objectively, seeing as you reference ‘studies have shown that exercise does not contribute to weight loss’ as a purported refutation of something I supposedly said. But I didn’t say what you think I did – I said that being sedentary correlates with weight gain, not the opposite. Your logical fallacy is ‘affirming the consequent’.

      • Andre Kruger

        Maybe the people are genetically predisposed being insulin resistant. They eat more carbohydrates than they can handle. This leads to high blood glucose and insulin levels which promotes the storage of fat. They eat “low fat” and high carbohydrate to loose weight. Not eating an optimal diet for their genetics they experience a drop in energy levels which leads to a more sedentary life style.

        Even if they have the “character” to push trough these obstacles they might still gain weight with age, becoming overweight. Remember those overweight Comrades Marathon runners. Prof. Tim Noakes likes to reference.

        This sound more plausible to me than “being sedentary correlates with weight gain”.

        But we don’t know, do we? All we are doing is speculating.

        • No, ‘we’ aren’t speculating. ‘I’ certainly am – some people claim to know, rather than express a hypothesis.

          • Andri Hanekom

            “some people claim to know, rather than express a hypothesis.”

            Is this stance any different to the majority of nutritional scientists whom state their “belief”?

            • We’re not talking about them. But I’m sure some of them have the same poor relationship with the scientific method, yes, and others don’t. The ones I link to in this post certainly don’t speak in the language of certainty, no.

        • Si

          There is in fact quite a lot of work going into Cardiac Rehabilitation session and education regarding (high) INactivity levels being a contributor to weight gain and CHD rather than high Activity levels leading to weight loss. I agree that you should be able to experiment on yourself to find the best piece of advice for you to use, and there is so much speculation going on; being proved and disproved on a regular basis. It might be a few years and studies will be release that LCHF diet causes a number of health defects, also might be a few years until it gets proven as gospel. The main thing this article is pointing at is there is a lack of research to prove either way and people are getting taken in by a big name making a bold suggestion, correct me if I am wrong. Also that there is a fair bit of contradictions being made with every claim. At the end of the day people need to take their own health into consideration and decide on a suitable option for them to take.